Skip to content Skip to navigation

Does anyone REALLY plan to use a PHR?

August 6, 2009
by Neal Ganguly
| Reprints

One of the themes of the meaningful use definition is the drive to provide the patient more access to, or control over, their health information. The 2011 objectives call for the ability for both hospitals and physicians (eligible providers) to provide patients with an electronic copy of their health information, while the 2013 objectives take it a step further requiring access for all patients to a personal health record (PHR) populated in real time with health data.

What is the administration trying to accomplish by this push? Is it more accountability on the part of the patient over their information? If so, what will that accomplish? I don’t know about the rest of you, but I’m pretty busy – over the years I’ve taken on more and more tasks that were once performed by others. I am my own travel agent and my own bank teller – but I’m not excited about being my own medical records clerk. True, it took many years for online travel and banking to reach the level of use seen today – but in those examples I could see the upside. I liked to be able to compare prices, and see what seat I could pick on the plane, or what specific features a hotel might have that would appeal to me. In the case of banking, I liked being able to pay my bills without writing out checks, buying stamps and finding a mailbox, or having to race to the bank by 3pm to make a deposit. What do I get if I control my health information? Some value proposition may exist that I’m not aware of, and if not, one will likely emerge – but I just don’t see it yet.

In the meantime, I do see the early requirements around PHR as a distraction from the true priority of health information exchange. Much effort will be required to build local, regional, and national HIEs. The PHR could be a byproduct of a health information exchange – ultimately benefitting from the universal ability to exchange data between disparate care settings. Requiring it up front seems to be putting the horse before the cart – independent of the existence of a value proposition for personal control of the information.

Topics

Comments

Frank,
We're on the same page. I did show my dad MS Excel. Since he wasn't already familiar with it, the learning curve to enter dates and ratios was a bit much.

I think you make the point in your post - it's a consumerism thing. The iPod, for example, works because a typical consumer can get stuff on it without knowing more than rudimentary iTune use. No files copying, conversion, navigating through directories, bit rates, or any of that stuff. And, to your point, you get to hear your enjoyable tunes when your done.

PHRs don't deliver the tunes or the consumer grade experience.

I suspect that's not true of the tethered PHRs from commercial vendors, or self-developed by Partners, CareGroup, (both in Boston) etc. My dad does not live in Boston, and his care providers in Maryland don't offer PHRs.  I know that's changing; my dad is 87.  We'd better hurry up!  or move...

Neal,

Interesting and provocative post. There's a couple of observations I'd like to share related to your points.

1) Is a provider or nationally tethered PHR the right way to go, versus a truly patient-controlled record? Read here for more:

www.ehealthinitiative.org/events/papers/QuardraMed_09-04-08.pdf

2) Is the technology for PHRs adequately mature, beyond "banking transaction-type functions" like scheduling appointments or getting a lab report document?

Case in point: My dad's blood pressure is not in ideal control. He's working with his doctor on adjusting medications and my dad is keeping his blood pressure log in Microsoft Word. The formatting is very frustrating for him, and, of course, Word is not designed for that task. So, I tried the blood pressure logging capability in Google Health two weeks ago to see if it was the way to go. It's not. The recordings are at the level of the day, not time of day. In his case, it's extremely important to sort out morning, afternoon, evening and night time blood pressures. No way to record at that level of granularity.

Based on the demo I saw of Google Health at HIMSS 2008 (one and a half years ago), I was led to believe that this PHR was ready-for-prime time. It wasn't. If there are third-party widgets necessary to complete the product, how was my octogenarian dad suppose to figure that out? How about his doctor or his son? (For sake of argument, let's assume the son is not a techie.)

My point is simple. Your "cart before the horse" sequencing point is a fair one. Once the horse is in place, the characteristics of the cart will become central. Who owns and controls it? Does it work? How is that defined?

And, incidentally, I am still looking for an alternative to MS Word as a PHR to track blood pressure data capture, paired with a medication history.

Neal, very interesting, but it really comes down to the individual.
re: What do I get if I control my health information? Some value proposition may exist that I'm not aware of, and if not, one will likely emerge — but I just don't see it yet.

How about...a better understanding of your situation, needs, reactions, and prognosis (eg. better healthcare).

Joe,
How about a simple excel spread sheet.
Or if you don't want Dad bouncing around excel cells,
a simple and quick Access program could do it.

Joe,

I agree that PHRs raise many questions regarding ownership and control - not to mention the liability issues that go along with control of information. Who is responsible for reconciling conflicting information that may flow from different sources? Should the patient ultimately be responsible for the accuracy of the information? Is that a reasonable expectation for anything beyond basic clinical data?

I do see the value of a PHR as a communication tool between those ailing from chronic conditions and their caregivers - but the benefits may not be realized if all the patient's and caregivers are using different systems. Those with chronic conditions may be more likely to track certain information such as blood pressure. Your example of the PHR not being able to log BP with sufficient specificity with respect to time would imply that the products are not yet mature. But the question I am grappling with is "who is the target market" for PHRs? The chronically ill?

Hi Neal,
I think the value people perceive is, as you say, from the use of a patient portal as a communication tool. That is, people would like to get a test result score and then e-mail their care providers with questions. For many physicians, this may raise questions of how they get compensated for time spent answering e-mails. But in integrated networks such as Kaiser that require it, these features are highly popular with consumers.

David,

Thanks for the comment. I agree that compensation needs to be aligned to better represent the services being rendered. Physician's are still not paid for phone consults either for the most part, yet do dispense clinical advice that way.

I do get your example of dealing with follow-up for tests using the PHR as a communication tool, but as you point out, that is working well in a fully integrated network. In areas where such networks do not exist, the infrastructure challenge arises. Who offers the PHR? Who maintains it? What happens if competing hospitals offer PHRs and a patient receives services at both hospitals?

The fact that it works well in a closed environment does send a message - and begs the question that Joe raised in the first item of his comment above "1) Is a provider or nationally tethered PHR the right way to go, versus a truly patient-controlled record?".

Neal Ganguly

CIO, CentraState Healthcare System, Freehold, New Jersey

Neal Ganguly explores the challenges facing community hospitals as they struggle to remain...